Incidence of Invasive Pneumococcal Disease in Children Has Significantly Increased Postpandemic

Incidence of invasive pneumococcal disease (IPD) among patients aged 21 years and younger has increased significantly following the COVID-19 pandemic, with decreased vaccination rates during and after the pandemic playing a role, according to data presented by investigators at IDWeek 2025 in Atlanta, Georgia.¹

How Did the Pandemic Impact Vaccination Rates?

The COVID-19 pandemic led to an unprecedented number of individuals practicing safe hygiene, undergoing social distancing, and receiving proactive vaccination to protect themselves and their loved ones. Simultaneously, in a phenomenon that became visible as the pandemic receded, vaccine mistrust and hesitancy grew. In the wake of the pandemic, many patients have exhibited skepticism towards vaccine recommendations and public health guidelines.²

Hesitancy towards vaccines has expanded beyond COVID-19 vaccines and can impact uptake of other key immunizations, including those protecting against Streptococcus pneumoniae, which can cause IPD. Since pneumococcal conjugate vaccines were introduced in the US in 2000, rates of IPD have substantially declined. Disease mitigation efforts implemented during the pandemic brought the incidence of IPD to a 30-year low, but since the relaxation of those measures, IPD incidence has slowly risen.^1,3

Vaccination in children has significantly improved outcomes and prevention of IPD, but the World Health Organization estimates that the bacteria causing IPD can kill about 300,000 children under 5 years worldwide each year. Declining pneumococcal vaccination rates threaten to increase the global mortality burden, especially in vulnerable pediatrics.^1,3

Has the Epidemiology of IPD Shifted Since the Pandemic?

At Children's Hospital Detroit, a group of investigators aimed to describe the epidemiology of IPD before and after the COVID-19 pandemic. Factors including treatment, microbiology, disease manifestations, and clinical outcomes were examined. The investigators reviewed records of young patients admitted to the hospital between January 2010 and February 2024, with individuals categorized into prepandemic (2016–2020) and pandemic/postpandemic (2020–2024) groups.¹

In total, 143 cases of IPD were included. Most cases (66.4%) featured patients aged 5 years or less, and 88 (61.5%) were males. Incidence of IPD decreased during the COVID-19 pandemic (from 2020 to 2021) but rebounded in 2022, increasing from 0.6–0.8 to 1.7 per 1000 admissions. Most patients were previously healthy prior to their diagnosis (53.8%), and 10 (6.9%) had sickle cell disease. Common presentations of IPD were bacteremia (n = 117; 82%) and complicated pneumonia (n = 37; 25.9%).¹

There was high susceptibility observed for key antibacterial treatments across the population. Ceftriaxone (Rocephin, Roche; n = 95/98, 97%) and penicillin (n = 90/100; 90%) susceptibility was high in nonmeningitis isolates. Despite this, lower susceptibility was reported for ceftriaxone (n = 8/22; 82%) and penicillin (n = 15/22; 68%) in meningitis isolates.¹

Serotyping was performed in 7.7% of cases, for which 63.6% were non-pneumococcal 13-valent conjugate vaccine (PCV13) serotypes. In 51% (n = 19/37) of tested patients, low pneumococcal titers were found, indicating incomplete or reduced vaccine protection. Contrastingly, 79% (n = 15/19) were fully immunized. Despite vaccinations, titers for pneumococcal 7-valent conjugate vaccine (PCV7)/PCV13 vaccine serotypes were low in analyzed patients.¹

There were no significant differences observed between the pre- and postpandemic periods in gender, age, or clinical presentation (P > .05). There was a substantial increase in the proportion of unimmunized children in the postpandemic period (18.6%) compared with the prepandemic period (4.1%), highlighting the newfound vulnerability of younger individuals in pneumococcal prevention efforts.¹

Pharmacists can be critical members of the patient care team when presented with a young patient at risk for IPD. Advocating for vaccination is a crucial first step, and novel strategies, including pharmacist-integrated education and utilization of new technologies, should be considered to increase vaccination uptake. Updated pneumococcal conjugate vaccines can also play an essential role in providing protection against the most burdensome and unsusceptible pneumococcal serotypes.¹

“Recognizing these epidemiological shifts and addressing vaccination gaps with the use of updated vaccines are critical to preventing future IPD outbreaks,” the study authors concluded.¹

REFERENCES

1. Habbal S, Abdel-Haq NM, Thomas R, Ang JY. (P-436) Epidemiology of pediatric invasive pneumococcal disease in an inner-city tertiary care center: A 13-year study and post-pandemic insights. Presented: IDWeek; October 20, 2025; Atlanta, GA. Accessed Online via IDWeek Virtual Platform on November 17, 2025.

2. Ortiz-Prado E, Suarez-Sangucho IA, Vasconez-Gonzalez J, et al. Pandemic paradox: How the COVID-19 crisis transformed vaccine hesitancy into a two-edged sword. Hum Vaccin Immunother. 2025;21(1):2543167. doi:10.1080/21645515.2025.2543167

3. Pneumococcal—Pneumococcal disease surveillance and trends. CDC. Last Updated September 9, 2024. Accessed November 17, 2025. https://www.cdc.gov/pneumococcal/php/surveillance/index.html